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My fellow Americans…
EDITOR’S PERSPECTIVE Paul B. Freeman, O.D.
My fellow Americansѧ
O
n July 30, 1965, as a part of President Lyndon B. Johnson’s “Great Society,” Medicare (and Medicaid) was signed into law. The intent of that law was to help fund the medical care of elderly Americans, many of whom had no health insurance. The first to enroll was President Harry S. Truman, himself a proponent of the national health care insurance plan. In those days, optometry was primarily a refractive profession, but optometrists were slowly moving into the arena of becoming primary eye care providers for all individuals, including the elderly. As optometry practice acts changed to allow broader diagnostic and therapeutic privileges and treatment modalities, it followed that inclusion and parity in this national health insurance program would be sought by our profession. And just as the Medicare program itself did not easily evolve, optometry’s entrance into the mainstream of this government program was repeatedly challenged as well. In January 1984, Congresswoman Barbara A. Mikulski gathered individuals representing optometry and ophthalmology, members of the blindness community, and some from the public health arena, to discuss legislation she had introduced as H.R. 3009 and H.R. 3010. Reading the transcripts, it is clear that she believed H.R. 3010 would: “remove the current exclusion in the Medicare program for eye and eyeglass examinations (this legislation will not reimburse the cost of eye glasses or contact lenses), reimburse all providers certified under state law to provide the services to Medicare patients, and require that all providers
who are reimbursed for these vision exams accept the Medicare determined ‘reasonable charge’ as the full charge.” Moreover, she felt that H.R. 3009 “would specifically provide Medicare coverage for these eye exams to the low vision population,” recognizing even then that low vision can “cause a lack of independence and often leads to institutionalization.” She then went on to cite a letter Congressman Claude Pepper sent her in support of H.R. 3010, stating, “Vision is perhaps the single most important sense upon which the nation’s elderly depend. Certainly its deterioration or loss dramatically reduces the quality of life and seriously threatens the ability of the aged to function independently.” After that, optometry (represented by Dr. David W. Ferris), ophthalmology, and others presented reasons why the profession of optometry should or should not be considered as part of this recommended amendment to the national healthcare program. As background, this makes for some very illuminating reading; nevertheless, how it played out is history. Optometry now celebrates 20 years of having parity with other health care professions in the nation’s largest health care program. During those 20 years, health care providers have watched the system morph from what might generally be considered as reasonable cost reimbursement to coverage based on specific formulas designed to contain the rapid upward spiraling cost of health care. Apart from whether one believes that optometry’s involvement in Medicare is “good” (beneficial) or “bad” (detrimental), no one can argue that those who fought so hard to
1529-1839/07/$ -see front matter © 2007 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2007.06.002
Paul B. Freeman, O.D.
achieve parity for optometry with other health care professionals not only gave our patients the opportunity to choose who will provide their eye care, but also afforded optometrists the opportunity individually decide if they wanted to participate in this plan (something we could not have thought about before that time). In doing so, this seminal event elevated the stature of our profession to that of a provider within the larger health care society. The members of the optometric community who worked tirelessly to get us there were, once again, the volunteers and staff of the American Optometric Association. Standing on the shoulders of those giants has allowed us the ability to move forward, and the chance to voice our input regarding many of the issues about the care and reimbursement of our senior patients (as well as those whose health care is
384 covered due to having a disability or end-stage renal disease) within this health care structure. And while the visually impaired population was not integral to that legislation (H.R 3009 did not move forward in the same way as did H.R. 3010), the Centers for Medicare and Medicaid Services and the professional vision rehabili-
Editorial tation community continue to explore ways to help the population of visually impaired Americans receive coverage for the services and devices they need. As the population ages, and chronic systemic health and eye diseases play an ever increasing role in the quality of life, there is now, and
will be in the future, a growing need for eye health and vision services. This event, 20 years ago, opened the door for optometry’s inclusion in providing that care and gave our patients the freedom of choice as to who will provide it. One can only wonder what the landscape will look like 20 years from now.
My fellow Americansѧ
O
n July 30, 1965, as a part of President Lyndon B. Johnson’s “Great Society,” Medicare (and Medicaid) was signed into law. The intent of that law was to help fund the medical care of elderly Americans, many of whom had no health insurance. The first to enroll was President Harry S. Truman, himself a proponent of the national health care insurance plan. In those days, optometry was primarily a refractive profession, but optometrists were slowly moving into the arena of becoming primary eye care providers for all individuals, including the elderly. As optometry practice acts changed to allow broader diagnostic and therapeutic privileges and treatment modalities, it followed that inclusion and parity in this national health insurance program would be sought by our profession. And just as the Medicare program itself did not easily evolve, optometry’s entrance into the mainstream of this government program was repeatedly challenged as well. In January 1984, Congresswoman Barbara A. Mikulski gathered individuals representing optometry and ophthalmology, members of the blindness community, and some from the public health arena, to discuss legislation she had introduced as H.R. 3009 and H.R. 3010. Reading the transcripts, it is clear that she believed H.R. 3010 would: “remove the current exclusion in the Medicare program for eye and eyeglass examinations (this legislation will not reimburse the cost of eye glasses or contact lenses), reimburse all providers certified under state law to provide the services to Medicare patients, and require that all providers
who are reimbursed for these vision exams accept the Medicare determined ‘reasonable charge’ as the full charge.” Moreover, she felt that H.R. 3009 “would specifically provide Medicare coverage for these eye exams to the low vision population,” recognizing even then that low vision can “cause a lack of independence and often leads to institutionalization.” She then went on to cite a letter Congressman Claude Pepper sent her in support of H.R. 3010, stating, “Vision is perhaps the single most important sense upon which the nation’s elderly depend. Certainly its deterioration or loss dramatically reduces the quality of life and seriously threatens the ability of the aged to function independently.” After that, optometry (represented by Dr. David W. Ferris), ophthalmology, and others presented reasons why the profession of optometry should or should not be considered as part of this recommended amendment to the national healthcare program. As background, this makes for some very illuminating reading; nevertheless, how it played out is history. Optometry now celebrates 20 years of having parity with other health care professions in the nation’s largest health care program. During those 20 years, health care providers have watched the system morph from what might generally be considered as reasonable cost reimbursement to coverage based on specific formulas designed to contain the rapid upward spiraling cost of health care. Apart from whether one believes that optometry’s involvement in Medicare is “good” (beneficial) or “bad” (detrimental), no one can argue that those who fought so hard to
1529-1839/07/$ -see front matter © 2007 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2007.06.002
Paul B. Freeman, O.D.
achieve parity for optometry with other health care professionals not only gave our patients the opportunity to choose who will provide their eye care, but also afforded optometrists the opportunity individually decide if they wanted to participate in this plan (something we could not have thought about before that time). In doing so, this seminal event elevated the stature of our profession to that of a provider within the larger health care society. The members of the optometric community who worked tirelessly to get us there were, once again, the volunteers and staff of the American Optometric Association. Standing on the shoulders of those giants has allowed us the ability to move forward, and the chance to voice our input regarding many of the issues about the care and reimbursement of our senior patients (as well as those whose health care is
384 covered due to having a disability or end-stage renal disease) within this health care structure. And while the visually impaired population was not integral to that legislation (H.R 3009 did not move forward in the same way as did H.R. 3010), the Centers for Medicare and Medicaid Services and the professional vision rehabili-
Editorial tation community continue to explore ways to help the population of visually impaired Americans receive coverage for the services and devices they need. As the population ages, and chronic systemic health and eye diseases play an ever increasing role in the quality of life, there is now, and
will be in the future, a growing need for eye health and vision services. This event, 20 years ago, opened the door for optometry’s inclusion in providing that care and gave our patients the freedom of choice as to who will provide it. One can only wonder what the landscape will look like 20 years from now.